Abstract
Light chain deposition disease(LCDD) is a rare cause of kidney failure. It is associated with multiple myeloma and is diagnosed by the evaluation of serum and urine free light chains. Patients who are diagnosed with this disease often develop rapidly progressive renal failure. To our knowledge, it does not have any association with other malignancies aside from multiple myeloma.We present a case that highlights a novel association between renal cell carcinoma and light chain-mediated renal disease. Our patient was admitted due to acute renal failure and underwent a comprehensive diagnostic evaluation with an eventual diagnosis of light chain glomerulopathy in the setting of metastatic renal cell carcinoma.
Highlights
Multiple myeloma is a plasma cell cancer that can lead to kidney disease
The results demonstrated 5-7% plasma cells with CD138 immunohistochemistry; concurrent flow cytometry revealed a 0.03% population of lambda-monotypic plasma cells suggestive of a plasma cell neoplasm
Light chain deposition disease (LCDD) and/or multiple myeloma should be considered in the differential diagnosis of patients who present with worsening renal disease, even in the setting of other known malignancies
Summary
Multiple myeloma is a plasma cell cancer that can lead to kidney disease. It has been traditionally characterized by unexplained anemia, renal dysfunction, bone pain, elevated total serum protein, and hypercalcemia. The fluid showed a lactate dehydrogenase (LDH) level of 1446, as well as a fluid/serum LDH ratio of 3.3 and a fluid/serum protein ratio of 0.6, all suggestive of a malignant effusion later confirmed by cytology His potassium and creatinine continued to trend upwards on day four of admission (6.6 mEq/L and 3.4 mg/dL respectively) his EKG remained unremarkable. He was started on Kayexalate and received another 1-liter bolus of NS due to persistent POCUS findings suggestive of hypovolemia. Prior to transfer to the ward, an SPEP and SIFE were obtained to evaluate his ongoing kidney disease; this demonstrated an elevated IgA lambda monoclonal peak suggestive of multiple myeloma. He opted to be discharged to hospice care at home on day 19 of admission
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